Prevalence of Mycophenolate Mofetil (MMF) Discontinuation and Outcomes in Pediatric Kidney Transplants (PKTX): A PNRC Study
1Nephrology, Children's National Med. Ctr., Washington, DC, 2Nephrology, Boston's Children's Hospital, Boston, MA, 3Nephrology, Wayne State University, Troy, DC, 4Nephrology, The University of Alabama, Birmingham, AL, 5Nephrology, Holtz Children's Hospital, Miami, FL, 6Nephrology, University of Iowa, Iowa City, IA, 7Nephrology, Children's Hospital of Georgia, Augusta, GA, 8Nephrology, Boston Children's Hospital, Boston, MA
Meeting: 2022 American Transplant Congress
Abstract number: 817
Keywords: Adverse effects, Immunosuppression, Kidney, Outcome
Topic: Clinical Science » Kidney » 43 - Kidney: Pediatrics
Session Information
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: MMF is discontinued in PKTX for various reasons. In this Pediatric Nephrology Research Consortium (PNRC) study, we determined prevalence and reasons for MMF discontinuation and its association with patient and allograft outcomes.
*Methods: Seven PNRC centers retrospectively reviewed PKTX between October 2011-October 2016. Data on induction, maintenance immunosuppression, reasons for MMF discontinuation, viral (CMV, EBV, BKV) replication, ACR, AMR, dnDSA, and hospitalizations were obtained. Clinical, lab data and eGFR were collected at transplant and every 6 months for 2 years. Characteristics and outcomes of patients in MMF discontinuation group were compared to MMF continuation group.
*Results: Of 288 PKTX (64% boys, 37% white, 30% black, 21% Hispanic), MMF was discontinued in 93 (32%), reasons for discontinuation included infection (35%), diarrhea (31%), and leukopenia (17%).There were no differences in age, sex, race, induction, steroids use, CMV or EBV mismatch between two groups. Children who discontinued MMF due to diarrhea were younger compared to other group (9.5+1.0 vs. 11.5+0.4 years, p=0.05). CAKUT children had higher MMF discontinuation (57% vs. 44%, p=0.04). Within PKTX<12 years, younger age was associated with increased likelihood of MMF discontinuation (β -0.01, p=0.01), this was not observed in older children. Prevalence of ACR, AMR, dnDSA and cumulative allo-immunity (ACR+, AMR+, dnDSA) did not differ between the two groups. Viral replications and hospitalizations were higher and a greater decline in median eGFR was observed in the MMF discontinuation group at 2 years post-TX (Table).
*Conclusions: A third of PKTX discontinue MMF within 2 years post-transplant, mostly due to either viral infections or diarrhea. Children discontinuing MMF are more likely to require hospitalization. While there are no differences in cumulative allo-immunity in the MMF discontinuation group, there is a greater eGFR decline over first 2 years, possibly related to viral infections and hospitalizations. Pre-emptive recognition of children at increased risk of MMF-associated complications may help to improve outcomes.
| Outcomes | MMF Discontinuation=95 | MMF continuation=193 | p value |
| ACR% | 25 | 17 | 0.11 |
| AMR% | 5 | 6 | 0.88 |
| De NovoDSA% | 25 | 20 | 0.37 |
| Allo-immunity(ACR+AMR+ DSA)% | 38 | 31 | 0.26 |
| Any viral replication% | 79 | 47 | <0.0001 |
| Hospitalizations % | 82 | 67 | 0.01 |
| Median change in GFR(ml/min/1.73m2) | -7.2 | -1.0 | 0.05 |
To cite this abstract in AMA style:
Moudgil A, Sgambat K, Benoit E, Jain A, Seifert M, Katsoufis C, Harshman L, Mansuri A, Somers M. Prevalence of Mycophenolate Mofetil (MMF) Discontinuation and Outcomes in Pediatric Kidney Transplants (PKTX): A PNRC Study [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/prevalence-of-mycophenolate-mofetil-mmf-discontinuation-and-outcomes-in-pediatric-kidney-transplants-pktx-a-pnrc-study/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress